How do Self Esteem and Self Image effect Anxiety, Agoraphobia, Panic, and Phobias?

Self Esteem and Self Image effect Anxiety, Agoraphobia, Panic, and Phobias a lot. I felt awful about myself throughout most of the fifteen years I suffered from anxiety and panic. Everything I did manage to do seemed to be second or third best, I seemed to be limited in all areas of my life. Equally everyone else seemed to be living life in the fast lane, travelling, partying, being successful, being popular, and being interesting. I had some girlfriends but I was a poor partner, my anxiety left me almost housebound and my low self confidence made my bedroom performance a bit lacklustre. I felt constantly tired yet could barely sleep, I was irritable and angry and lost friends. I believe a low feeling of self-worth was at least a partial cause of my anxiety in the first place, and my nose-diving self esteem, unsurprisingly, made my anxiety worse. It was, to coin a cliché, a vicious circle.

There were two issues to deal with. The low self esteem that was causal to my anxiety and therefore potentially still part of the problem, and the low self esteem which was caused by my anxiety. Both had to change.You tend to reap what you sow. If you feel nervous, unworthy, or un-cool you tend to give that impression to the people around you. Unsurprisingly, they treat you as though you were boring, because you are too tongue-tied to say anything interesting or funny, they look down their noses at you because they think you are unworthy, and they prefer to speak to cooler people. You largely chose how people react to you.

1) Most of what we feel, and most of what happens to us, is chosen by us. It is almost entirely in our control. Understanding this and keeping an eye out for the subtle choices you make all the time is highly important.



So when I had recognised that how people reacted to me was largely a self-fulfilling prophecy I had to chose how I wanted them to react to me. Although it may seem negative and unpleasant one thing I did was to bring them down to my level. Instead of looking at them as perfect and me as flawed I looked at us as both flawed. For example I said to myself “I may have anxiety, but he is so arrogant everyone is rude about him behind his back.” Or “He has been round the world but now he’s starting a career in management consultancy, what a dull boy. At least I am an interesting person inside.” In this way I met people as equals, and eventually with a healthy feeling of superiority. Of course when you have low self esteem you want to be liked, even need to be liked. The more people don’t instantly take to you, the more you want them to and the less they do. You are liked most when you are being yourself without a care in the world. In order to achieve this I made a list of all the people I could think of whom I disliked or felt neutral to at first sight, but grew to like or even love over time. The list was massive. I made an equally long list of people I liked instantly and grew to hate or fear. First impressions DON’Tcount! Relationships between friends, colleagues and lovers evolve and grow naturally. “First impressions count” is a mantra repeated by companies which sell shampoo and deodorant. Don’t give too much to soon, people like to earn respect. I, like almost everyone else, am wary of people who are desperate to be loved and try too hard. No one is universally liked, unless they are very false and tell everyone what they what to here. If someone doesn’t like you it doesn’t matter. Maybe they will grow to like you or maybe they won’t. Either way you will still be you.

People often say they wished they were someone else. I felt like that. When I stopped to think about it though I was wrong, I wanted to be me, even at my lowest ebb. Sometimes you want to be as good looking as someone, as clever as someone else, as rich as a third person. I wracked my brains about every person I considered successful and offered myself the opportunity to take on no just the parts I liked but their whole being. There was not a single person I would have rather been. I didn’t want their parents, their looks, their troubled past, their annoying voice, their premature grey hair or yellow teeth. Statistics say that only one-in-five successful entrepreneurs had both parents alive through their childhood. So they may be rich, but their toughness is built of grief and hardship. It’s all very well envying their wealth, but would you really want to be them? Try making your own lists of people you did and didn’t like at first sight. Think about the people you envy and assess how much you would like to actually be them, warts and all.Often self esteem issues stem from childhood and how parents and care-givers react to you and around you. In extreme cases the way an anxiety sufferer was treated as a child might constitute abuse and cruelty. More likely as children, like me, the average sufferer felt scared and unloved. It is helpful for both now and dealing with the past to understand how people treated you. The truth is that as children we are all a little self obsessive. We believe the world is run for us and that everything is to do with us. We also tend to blame ourselves for how people respond to us and treat us. What we often forget or don’t know is that people have their own personalities and trains of thought which might well be far more complex than we can guess. The reasons they react as they do are not then because of us, even if they appear to be reacting to something we’ve done. Those people, such as parents, give off their own personalities in all directions for a whole range of reasons to do with what is going on in their life, or has happened to them in the past.3) I started to see that when people were angry or offish with me, they were giving that negative vibe off in all directions, and that it was affecting all people around them. This did not mean I could wash my hands of something I had done which deserved atonement. It did mean that I could understand that my parents were not uncaring to me; they were generally emotionally distant in all areas of their lives. It hadn’t been my fault. The diagram below illustrates this. Try drawing your own.4) You are not as crap as you think. While you have been suffering from panic attacks and anxiety you, like I, may have felt that you have missed out a lot, let life pass you by, or are growing old without having achieved your full potential. Like before it is easy to look at others and see them as so much more successful than you. In my case my achievements had certainly not been so obvious; I had not been round the world, been for a night out in London or been offered a job by a top city company. I had done many things though, and I illustrated this to myself by writing a list of them. I have included my list here. As you can see, they show that I was a unique, interesting human being with a life going on around them in which I play a full roll. Try writing your own list to see how much you have achieved. And remember that you will achieve more and more as you recover. You self esteem may not magically rise, but bit by bit you can respect yourself more, and as you respect yourself more you will achieve more.

Want to be cured of Anxiety? Or do you have Secondary Gain?

Do you want to be cured of anxiety? The question is much more serious than many people think. Almost everyone with anxiety, panic attacks, or phobias has a reason for keeping hold of it. When I had severe anxiety I dearly wanted to travel. I spent endless hours dreaming of where I would go and what I would do. I poured over atlases and became expert in how I could travel to far flung destinations without flying. The funny thing was, I really didn’t want to go. When I started to look into secondary gain I realised that the idea of being away from home, taking responsibility for myself, being in a foreign country all alone, and exposing myself to lots of danger absolutely petrified me to the core!

Imagine a miracle cure was possible. Imagine it took the form of a drug with no side effects and no risks. You can take one pill and be cured forever. What would you do? Would you travel the world? Go to the top of a tall building? Drive really fast a long a freeway? Go out and take risks? I suspect that you wouldn’t. I think there are things about getting over anxiety which probably scare you enough to make you sabotage your own efforts.There are two main keys to getting over your secondary gain. The first is to identify it. This is easier said than done. Although I don’t think secondary gain is so deeply buried that you need to do anything radical to find it, it can be hard to find. Sometimes it’s a case of not seeing the wood for the trees. It can be so powerful that when it is dealt with, and you actually want to get over your anxiety with your heart and mind, the whole process becomes much easier. I do not believe that if you deal with the initial cause you will instantly find your solution. I do however believe that if you stop sabotaging your efforts to recover your recovery will be quicker and easier.

To find your secondary gain you can use the following process.Getting Secondary Gain into the open Take a piece of paper and list all the downsides of having anxiety, panic attacks or a specific phobia. Then list the upsides of keeping hold of them. Keep the piece of paper close to hand for a few days and add to it every time you think of something.a meditation techniques to focus on the issue of secondary gain. Give yourself permission to become conscious, over the coming hours, days and weeks, of any secondary gain you are getting from your anxiety. The ensuing thoughts may include some odd things, perhaps linked to childhood memories or perhaps something completely different. Either way, note them down on your list.Use a self hypnosis method to speak to your internal counsellor. Ask if there is a reason why you are sabotaging your recovery. Again, give your internal counsellor permission to provide answers at any time, even in dreams. It is important that you keep your list to hand or write down your secondary gains elsewhere to be added to your list later.

Allow a few weeks for your list to become complete. Then set about changing thought patterns.When you have an opportunity to try and beat your anxiety, do you leap at it? Or do you find yourself saying “Hey, I’ll do it tomorrow.”? Sometimes this is also down to secondary gain, and therefore you might find it hard to start tackling your secondary gain. The key is to not see it as a mountain to climb. Instead take a first step and chip away at it. Do it bit by bit, agreeing with yourself to do just a few minutes work, if motivation is low. Eventually you will be pulling away secondary gain in chunks, and before you know it you will be free of it!

Psychotherapy for Anxiety

        Psychotherapy is often used with reference to a whole range of therapies, including

cognitive behavioural therapy

      , which I have talked about elsewhere on this site. Here we will focus on psychotherapy in terms of analytical therapy as opposed to more active therapies where you challenge very specific problems.


Psychoanalysis has a bad name!

Analytical therapies are out of fashion. Their grandfather, Freud, has been largely discredited and mocked by most modern psychologists. Treatment takes a significant amount of time and therefore results are hard to quantify with statistical analysis. The advent of SSRI drugs like prozac and citalopram have proved to be a cheaper, less troublesome option for the medical profession who have never really understood that drugs work on symptoms and not solutions. Also, CBT, which is great for simple phobias, has been overused on more complex issues where its results are less impressive (although it can still be useful).

All in all it seems that people stay in therapy for years, handing thousands of pounds to therapists that they come to rely on and never getting any better. This is definitely not always the case. There are some steps to help ensure successful therapy. Read on.

Is it right for me?

Obviously it is hard for anyone except you and a qualified, certified, impartial therapist to make that assessment. But I will offer my opinion. If you have a specific problem which is not suitable for CBT due to its complexity, or has not responded to CBT very well, then it is worth investigating.

Will it take years?

No therapist can tell you exactly how long you may need therapy for. When they know you, they may have a gut feeling which you can use as a guide. Certainly some people do get stuck in a therapy-trap where they just use their therapists as a sounding board and never really act on what they have learnt or move forward. If you don’t want to get into this trip you should have a clear idea of what you want to achieve, and be prepared to make changes in your thoughts and actions. Therapy is not magic, you will hae to work for your results.

What happens during therapy?

There are so many different types and schools that that is an impossible answer. If your therapist is well qualified and certified by the relevant authority in your country, you should have no reason to fear. And the therapist should give you insight into how they work in an initial consultation before you decide whether they are right for you.

My advice would be to accept what you don’t understand and go with it. The mind’s working and communication are not logical and straight forward like conscious thought. Remember that.

Reader’s opinions of therapy would be greatly appreciated!


Prozac – Fluoxetine – User’s experiences

        Here are what some readers said about their experiences with Prozac (also known as fluoxetine), which is a very popular SSRI. It was hailed as a wonder drug for depression but then became controversial as people suffered serious side effects and its miraculous results were not universally experienced.If you would like to share your experience of Prozac, click


       to send an email.

Jenny, Yorkshire UK

“The doctor put me on Prozac for OCD. Before I took this drug I could barely function in life. At first I made great improvements but now I am starting to think that it’s not doing me as much good as it was before. Now the doctor has talked about switching me to Celexa instead to see if that makes a difference.”


Amandine, Lyon FR

“At first My doc started me on 10mg of Prozac and I felt great! I had stacks of energy and wasn’t my usual fatigued self. Despite sleeping only a few hours a night! The insomnia didn’t bother me. The doctor said he wanted me to go up to 40mg eventually. Things went well for a few weeks then dropped back. My anxiety returned. The doctor put me up to the 20mg dose and I felt good for another few weeks. The insomnia stayed and I had odd dreams, like I was on LSD or something.
I also felt strangely assertive, something which was very rare for me.After two months at 20mg of Prozac I started to suffer from hypochondria. I was hyper-sensitive to all the feelings in my body and convinced something was wrong with me. I was sure I had AIDS, Cancer and an appendicitis! All of which were of course false.My doctor moved me up to 40mg and I got worse still. I was still obsessing about my health, but now I was also suffering from a bad memory, poor concentration and minor paranoia.I came down from the 40mg dose slowly to 10mg and felt OK again, but still with some anxiety. My new doctor switched me to Lexapro.Remember, the side effects need to be outweighed by the benefits!”

Mike, Buffalo US

I have used Prozac for well-over a decade and it has done me the power of good! It is much much better than the previous rubbish I had been on. I started on a small dose but didn’t really feel better until I was taking 90mg a day. Now I have dropped to 60mg a day and take a couple of Xanax if I feel over anxious or worried about something. Of course it would be better if one tablet did the whole lot, as Xanax leaves me a bit dopey. But I can’t complain.


What’s the difference between a fear and a phobia?

Phobias occur when fears become unreasonable. We all have fears and we all need them to keep safe. A fear of heights is a good thing as it keeps us away from the edge of the cliff. If your fear of heights stops you going above the third floor then this is a phobia. The fear is unneeded, unhelpful, and disabling to your life.

There are many common phobias such as agoraphobia (the fear of open spaces), flying phobia, phobias of spiders, enclosed spaces (claustrophobia) and many, many more. If you have a fear which is limiting your life know is the time to take action. Phobias can be completely overcome. There are people who have been so terrified they wouldn’t get onto a plane who now have their pilots licence. If they can get over a phobia to such an extent then so can you.

In truth the exactlabel of what is just a fear and what is a phobia is completely unhelpful and unecessary. If it bothers you then do something about it, and most of what works for phobias will work for fears. Start challenging it now.

Flooding for Phobias

Flooding for Phobias. Millions of people have phobias, lots of people get over them and lots of people have them for life. The web is awash with millions of dollars worth of treatment plans, quick cures, fast cures, miracle cures and lots more beside.

Over the last five decades, when phobia treatments have become more numerous and more successful, Cognitive Behaviour Therapy has become the mainstream treatment of choice. This is popular because it seems to work well for a reasonably high percentage of people that suffer from phobias, especially simple phobias like fear of heights.

Other phobia treatments that claim to work faster are often bogus, as they miss out one core part of tackling a phobia: The doing.

When you overcome a phobia you have to actually do, or be exposed to, the thing that once brought on a panic reaction in you. Nowadays, most people go for graded exposure which is on of the central tenets of CBT. The graded exposure is part of the “behavioural” part.

Some people still go in for “flooding”.

Flooding is, as the name suggests, a technique where by instead of breaking down a problem into sizeable chunks and slowly exposing yourself to it more and more, you jump in off the deep end and expose yourself to the lot. For example, a claustrophobic patient might voluntarily be shut or even locked in a cupboard, a patient with a fear of heights might go to the top of a tall building and look over the side.

As I’m sure you can imagine this could be a rather extreme and nerve-racking business. It takes a lot of courage.

There are some reasons why the flooding technique might be worth a look, even though it is largely considered out of date:

It is cheap
If it works it is quick
There is no need for therapy
If it works it is incredibly empowering
There are also some negative points to note:

Its success rate is not good
Its relapse rate is not good
It is incredibly hard to do and can be traumatic

If you think flooding might be for you I strongly advise you to seek professional guidance. It is (just) conceivable that simple phobias hide deeper psychological problems that could be uncovered. More to the point you want to have someone with you before you take on anything that scares you that much, for moral support if nothing else .

In a nutshell, try it if you want but I don’t recommend it.

Further reading:




Advice for friends and family coping with anxiety sufferers

What should you do when a friend, partner or family member suffers from anxiety, panic attacks, or phobias? It can be hard to cope with. Of course it’s frustrating to see someone change so much for the worst, often going from being bright and happy and outgoing to a gibbering wreck. You can play a role in their recovery. First a word of warning. Whatever horrors you have been through in your life, even if it includes war and famine, you have not had to deal with an anxiety disorder. Let me explain.

Anxiety and panic is nature’s way of making you avoid situations and escape from danger. It has been honed through millennia of evolution (or created by god!) to be the most unpleasant driving force possible. Yes, it is harmless but fighting against can be like fighting against mother nature herself. You don’t know what it’s like and hopefully you never will. I pity you having to be around a sufferer, but it’s time for you to look inside yourself now as well, and see if you can’t find a little resolve of your own. Here’s my advice to you:

  • Congratulate the anxiety or panic sufferer, they have admitted that they have a problem and are starting to fight it. They are braver than you ever need be.
    Ask them what you can do to help them get better. If they say “nothing” respect that.
  • Do your homework. Read up, search the web for anxiety, panic attacks, agoraphobia. Become an expert.
  • Be patient. They can shift anxiety quickly, but if they are under pressure it will take much much much longer.
  • Offer to be with them for exposure to phobic situations or panicky times, but don’t push them.
  • Don’t lose your temper, it doesn’t help. If you feel frustrated by a punch bag.
    Raise their self-esteem; this always helps anxiety sufferers.
  • Making them feel worse will make their recovery slower/impossible.
  • Have faith in them, even when they have none in themselves.

If you suffer from anxiety, read about how to cope with your friends, partners, and family.


Exposure Therapy for Phobias

Exposure Therapy for phobias: the truth of the matter is that sooner or later you have to face whatever it is that has caused you anxiety, panic attacks or a phobic reaction of some kind. If you never face it than you can never say you have beaten anxiety, panic attacks, or phobias. If you have no intention of facing it then you may as well give up fighting it.

Does that mean exposure therapy has to be a nightmare?

No! Exposure doesn’t have to be a nightmare, and if you do your preparation properly it can be easy and even fun. When it comes to exposure you have two broad choices: graded exposure and flooding. Here I will talk about graded exposure, for an explanation of flooding click here.

Graded exposure involves meeting the fear provoking situation gradually, starting with a very mild example. But before you actually start on that mild situation in real life there are foundations to be laid.
Firstly, if you have had success with exposure before but subsequently had major setbacks it is worth reading up about dealing with past trauma. Also read about setbacks. If you deal with underlying causes exposure may be ridiculously easy, or at least be a quicker and more painless process.
Before you start Graded Exposure, and before each subsequent step, do visualization. Lots of people say they can’t visualise but in truth everybody can. And with practice it gets better and becomes not just valuable in tackling a phobia but also in every other area of your life where you are trying to achieve something, like performing well in a job interview. For a crash course in Visualization click here.

Escitalopram for Anxiety

Escitalopram oxalate is an SSRI anxiety and anti-depressant medication made by Lundbeck, a pharmaceutical company based in Danemark who also produced Citalopram, the forerunner of escitalopram. It is commonly prescribed for anxiety, depression and OCD.

Escitalopram is more commonly known by marketing names such as:

  • Lexapro
  • Cipralex
  • Esertia

One doctor told me that escitalopram is effectively identical to citalopram, and that the manufacturers just released it with a minor change when the patent on the drug expires and other companies make cheap generics. Whether this is true or not cannot be verified at this time. That said, Wikipedia entries for each drug show the chemical make-up and to the untrained eye they look suspiciously similar.

The makers claim escitalopram is more effective at lower doses and has a much better side effect profile, meaning that it is well tolerated with fewer side effects and easier withdrawal.

Here are some opinions of people who have used this drug for anxiety, panic attacks or depression.

“Thank you Lexapro!”

“I take escitalopram (Lexapro) for fairly mild depression, anxiety and shyness. I think that taking Lexapro has made me less shy and more assertive socially and professionally. I have been on it for six years and on balance the improvements have been marvelous! There have been some side effects though. Gradually I have put on the pounds, no one warned me I might gain weight. My libido has suffered and my dreams are like strange LSD trips! I can put up with this in order to have my life back!”

“No panic Disorder…and no sleep! Insomnia!”

“I had only had two panic attacks (which occurred after difficult traumatic personal events) and with hindsight maybe going straight for medication was a mistake when I should have tried to deal with what I was going through.

The first three or four days were WEIRD (my doctor said they might be) but it is hard to put into words how weird they were. I felt “spacey” and tingly all over, especially in my hands and feet.

The side effects went away after a few days and I felt better however no matter what I couldn’t sleep the whole time I took Lexapro. Too many days I was still awake when the sun came up and started to shine through my bedroom window. I have had insomnia before, but not like this! Mornings were a nightmare and I slept all weekend to make up for it.

So most of the panic was removed from my life but the insomnia was too much to bare, so I changed medication.”

For more information on escitalopram why not visit the official manufacturers site. Also read this blog entry on SSRI withdrawal.

What are the best anti-anxiety medications?

Many people have success with anti anxiety medications, and other people have no success at all. Some people react badly to the drugs and get severe side effects, others find they don’t work, and others take an almost ethical stance that psychiatric medicine is wrong.

Drugs used to treat anxiety and panic attacks are normally either Selective Serotonin Re-uptake Inhibitors (SSRI) such as Prozac, Celexa, Lexapro etc, or Benzodiazapines such as Valium, Xanax, and Lorazepam. The former take several weeks to work while the latter normally take effect within an hour and can be used on an as needed basis (depending on your doctor’s advice!!). Nowadays doctors also prescribe Serotonin–norepinephrine reuptake inhibitors (SNRIs) for anxiety.

Do they Work?

Benzodiazepines definitely do work, with alprazolam (Xanax) of cited as the most effective. But they are VERY addictive and great care should be taken over using them. Beware that if you take them for any length of time you might have to taper off them. Benzodiazepine addiction is nasty. As for SSRIs and SNRIs opinion is somewhat divided over their efficacy. A meta analysis in 2010 concluded:

“The magnitude of benefit of antidepressant medication compared with placebo … may be minimal or nonexistent, on average, in patients with mild or moderate symptoms. For patients with very severe depression, the benefit of medications over placebo is substantial.

This is referring to their treatment of depression and not anxiety. The evidence for their usefulness in treating anxiety is unclear.

Alternatives to Medication

There are natural alternatives which have not been fully studied so their efficacy is hard to assess. Both Tryptophan and 5-HTP have been suggested as worthwhile alternatives and might be worth exploring further.

Which Medications are Best?

There is no answer to that question. Some anti anxiety and anti panic attack drugs work well for some people and not others. It is a case of trusting in your healthcare providers knowledge and being prepared to experiment a little. Alternatively you could chose to tackle your anxiety or panic attacks through Cognitive Behaviour Therapy or by looking at underlying health conditions that can cause anxiety alone (Killing Anxiety From The Roots is all about this). Remember, drugs treat symptoms and not causes. Your end goal should be to be free of anxiety without having to rely on drugs.

Speak to your doctor about drugs and avoid the temptation cheap online pharmacies. I would say that unless your anxiety is acute or you suffer severe panic attacks you probably do not need heavy tranquillisers such as Xanax, Valium, Klonopin and the like. When you factor in the dangers of dependence and addiction you may as well give them a miss or use them extremely sparingly.

SSRIs on the other hand probably have an effect on general anxiety and worry. They are thought to lift mood through increasing your level of the neurotransmitter Serotonin and the results for anxiety sufferers varies from a dramatic cessation of symptoms to mild relief. It should be said that a sizable number of anxiety sufferers get no benefit from SSRIs or find the side-effects to much to handle.

People often ask which anti-anxiety medication is best. The answer is that every drug and pill works differently for different people so that question can not be answered. I was once told by a highly accomplished therapist that Lexapro (escitalopam) was the best only to meet the same day a doctor who refused to prescribe it, insisting that Celexa (citalopam) was the only way forward. It is generally accepted that Paxil (paroxetine), also known as Seroxat, id one of the hardest SSRI meds to quit due to it’s half life.

The bottom line is: talk to your doctor and make sure drugs are not your only defence against anxiety, panic attacks, and depression. You need to tackle underlying causes as well. And don’t try and use over the counter medication or drugs to tackle anxiety and panic, it won’t work and some of that stuff can be dangerous if taken repeatedly.


The Drugs for Anxiety section is here.